Transfer of the flexor digitorum brevis tendon

Abstract

Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw or hammer toe deformities. In contrast, a search of the literature revealed no previous reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions. We performed a cadaver study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect. Transposition of the flexor digitorum brevis tendon was attempted in 180 toes of cadaver feet: 45 second toes, 45 third toes, 45 fourth toes, and 45 fifth toes. The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes and in 42 (93.3%) of the fifth toes. In the three remaining fifth toes (6.7%), the flexor digitorum brevis tendon was absent, a known anatomical variation. In conclusion, transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for correction of claw or hammer toe deformities, especially in the second, third, and fourth toes. The transverse aponeurotic fibers originating from the extensor digitorum longus impede the transfer of the flexor digitorum brevis tendon, and meticulous excision of these fibers is essential to the success of the procedure.